Washington Occupational Injury and Illness Surveillance and Prevention Program
Principal Investigator: David Bonauto, MD, MPH
Washington State Department of Labor and Industries
Safety and Health Assessment and Research for Prevention (SHARP) Program
Annual Report of Accomplishments and Outcomes, July 1, 2012-June 30, 2013
Washington Fundamental Occupational Safety and Health Surveillance Program
Program Director: David Bonauto, MD, MPH, bone235@Lni.wa.gov, (360) 902-5664
Project Epidemiologist: Naomi Anderson, MPH, anna235@lni.wa.gov, (360) 902-4957
The goal of Washington State’s fundamental occupational safety and health surveillance
program is to enhance capacity to provide information for action to improve the occupational
safety and health of Washington’s 3.3 million workers working at any of the 160,000 employers
within the state.
1. The Occupational Health Indicator data describes the occupational health status of the
Washington State working population. Washington collaborates with other NIOSH funded
states to publish the indicator data on the CSTE website. Publication of the collaborative
datasets often lags the availability of the data for individual indicator completion.
Output: Washington State has accelerated the publication of the twenty CSTE
Occupational Health Indicators on the Washington State Department of Labor Website.
We publish quarterly to semiannual web-based updates of the most current indicator
data available for Washington State. The data updates are available at
http://www.lni.wa.gov/Safety/Research/Pubs/#Surveillance.
2. The NIOSH-funded Washington State occupational health surveillance program has core
expertise in using varied state-level data resources (e.g. workers compensation data, hospital
discharge data) to respond to emerging hazards and data requests from employers, workers,
and groups representing employer and employees.
Intermediate Outcome: The WA Occupational Health Surveillance Program submitted
detailed industry, occupation, process, and task data for 27 cases of isocyanateinduced asthma to OSHA to inform the development of OSHA's National Emphasis
Program (NEP) on isocyanates.
Output: Data from Washington State’s work-related asthma surveillance system were
used to characterize isocyanate-induced asthma cases occurring from 1999 through
2010. A paper was submitted for peer-review publication to JOEH in
November/December 2012.

Key observations are made regarding the development of work-related asthma in
association with a) paint application on large objects difficult to ventilate, b)
indirect exposure to isocyanates, c) exposure during secondary or clean-up
processes, and d) reports of dermal exposure. If used these observations may
lessen the risk of isocyanate asthma.
Output: A breakout session presentation was made at the Council of State and
Territorial Epidemiologists (CSTE) June 2013 Annual Conference that discussed the
results of the isocyanates-induced asthma cases in WA from 1999 through 2010.
3. Surveillance data that systematically evaluates occupational injury and illness by industry
are relatively scarce, as are resources for prevention. Washington State periodically produces
a report prioritizing industries for prevention efforts based on high rate and high count of
workers’ compensation claims using a Prevention Index (PI) to identify where injuries are
occurring, and where the most benefit from research and prevention could be gained.
Output: A Technical Report was published in April 2013 which examines which
industry groups are at high risk for seven common injury types in Washington State to
establish a basis for efficient targeting of prevention resources. Between 2002-2010,
there were 267,581 compensable Washington SF claims. These accounted for over 11
billion dollars in direct workers’ compensation costs.

The top 5 industry groups for ‘All Injury Types’ were: Foundation, Structure, and
Building Exterior Contractors (NAICS 2381); Residential Building Construction
(NAICS 2361); Building Finishing Contractors (NAICS 2383); General Freight
Trucking (NAICS 4841); and Building Equipment Contractors (NAICS 2382).
These 4 Construction industry groups are ranked highly for prevention in the PIs
for almost all of the 7 identified injury types. Logging (NAICS 1133), Other
Specialty Trade Contractors (NAICS 2389), and Services to Buildings and
Dwellings (NAICS 5617) also appear in the Top 25 of all 7 identified common
injury types.
Output: A breakout session presentation was made at the Council of State and
Territorial Epidemiologists (CSTE) June 2013 Annual Conference that discussed the
methodology of the PI framework, our most recent published results, and preliminary
results of expanding the PI framework to include some measure of severity.
Intermediate Outcome: The Prevention Index (PI) framework has been adopted by
WA’s Division of Occupational Health and Safety (DOSH) which has begun to use the
PI framework and produce material in accordance with this methodology for education
and outreach activities.
4. Very little data are available to describe health and health behaviors of the workforce at the
state level by the workers’ industry and occupation of employment. Washington State has
collected Industry and Occupation (I/O) data from 1997 through 2011 on the Washington State
Behavioral Risk Factor Surveillance System (BRFSS). We have coded I/O for nearly 80,000
Washington State BRFSS respondents for the years 2003 – 2010.
Output: We produced a paper further describing and analyzing the distribution of selfreported ILI in Washington, and identifying occupations with increased risk of ILI,
published by PLOS ONE in November 2012 (with 1,346 views and 6 social shares as of
June 2013).
 ‘Janitors and Cleaners’ (PR 2.5; 95% CI 1.3, 4.7) and ‘Secretaries’ (PR 2.4; 95%
CI 1.1, 5.4) had an increased risk of ILI as compared to the overall prevalence
and a reference group; while ‘Truck Drivers’ (PR 0.2; 95% CI 0.1, 0.7) and
‘Technicians, not elsewhere classified’ (PR 0.4; 95% CI 0.2, 0.9) had lower risk of
ILI than other occupations that were analyzed.
Output: Obesity is a threat to public health. The prevalence of obesity has increased in
the United States in recent decades, and is associated with sick leave, absenteeism,
increased risk of cancers, musculoskeletal disorders, cardiovascular disease, and
stress. Estimating the prevalence of obesity across occupational categories can help
identify at-risk populations, and aid in the development of targeted prevention efforts.
Using BRFSS data (odd numbered years 2003-2009), we estimated the prevalence of
workers across occupational categories in WA. A paper on these data was submitted for
peer-review publication in June 2013.
 The overall prevalence of obesity for all workers was 24.6% (95% CI 24.0 – 25.1),
ranging from 11.6% (95% CI 8.0 – 15.2) for Health Diagnosing Occupations to
38.6% (95% CI 33.3 – 44.0) for Truck Drivers. There was significant disparity in
obesity prevalence (as well as intake of fruits and vegetables, and levels of
Leisure Time Physical Activity) across occupations in WA. Several occupations
with significantly higher prevalence estimates of obesity compared to the
reference group (Health Diagnosing Occupations) included Truck Drivers,
Transportation and Material Moving, Protective Services, and Cleaning/Building
Services.
Output: A breakout session presentation was made at the Council of State and
Territorial Epidemiologists (CSTE) June 2013 Annual Conference that discussed a
variety of Washington State Occupational Injury and Illness Surveillance and Prevention
Program’s published analyses of BRFSS Industry & Occupation data, particularly
results demonstrating the differences by occupation in: underreporting of work-related
injury; depression & frequent mental distress; obesity; and influenza-like illness.
Major Outputs:
Anderson NJ, Bonauto DK, Fan ZJ, Spector J. Distribution of Influenza-like Illness (ILI) by
Occupation in Washington State, September 2009-August 2010. PLOS ONE.
2012;7(11):e48806.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0048806
Anderson N, Bonauto D, Adams D. Prioritizing Industries for Occupational Injury and Illness
Prevention and Research, Washington State Workers' Compensation Claims Data, 2002-2010.
Washington State Department of Labor & Industries; Olympia, WA. April 2013. Technical
Report #64-1-2013. http://www.lni.wa.gov/Safety/Research/Files/bd_3F.pdf
Bonauto D, Lu D, Fan ZJ.. Preventing Chronic Disease. In process, submitted June 19, 2013.
Reeb-Whitaker C, Anderson NJ, Bonauto DK. Prevention Guidance for Isocyanate-induced
Asthma using Occupational Surveillance Data. Journal of Occupational & Environmental
Hygiene. In production, submitted November/December 2012.
Washington Fatality Assessment and Control Evaluation (WA FACE) Program
Program Director: Todd Schoonover, PhD, scto235@Lni.wa.gov, (360) 902-5663
The goal of the Washington State FACE program is to prevent workplace fatalities through
surveillance, fatality investigations, and prevention activities.
1. Improving Safety through targeted distribution of new WA FACE Materials
A. Output: Prevention resources on the web: From July 2012 – June 2013, WA FACE
created new prevention resources for employers, health and safety professionals, and workers
(see www.lni.wa.gov/Safety/Research/FACE/default.asp):
 10 Fatality Narratives (Construction (n=8), Agriculture (n=2)).
 4 FACE Fatality Investigation Reports.
 2 Hazard Alerts (1 in English and Spanish).
Each new prevention resource contains incident-specific prevention recommendations.
Combined, these resources were directly distributed via 9100 email messages. FACE
maintains growing distribution lists for these publications. There were 233,306 webserver
requests for FACE prevention resources, an increase of 13% from the previous year.
B. Intermediate Outcome: Prevention resources targeting specific industries by trade
journal: WA FACE collaborated with industry trade associations to publish and distribute
investigation findings and recommendations. These are effective methods to influence hazard
awareness, safety training and practices, and safe product design. WA FACE successfully
submitted findings and recommendations to the following trade journals:
 American Machinist Magazine: Washington State's Fatality Assessment and Control
Evaluation (FACE) Program issues recommendations for protecting lathe operators,
published December 13, 2012.
 Good Fruit Grower: Orchard safety spotlight, published April 2013.
C. Potential Outcome: Prevention resources targeting specific employers: WA FACE
utilized the WA State workers’ compensation database to effectively communicate prevention
messages to employers at risk of specific hazards.
WA FACE Fatality Narratives:
 131 copies of “Deck Engineer on Barge Dies When Struck by Crane Counterweight in
Washington State” mailed to WA risk class-mobile crane and hoisting services employers.
 267 copies of “Carpet Installer Dies after Falling 32 Feet at a Commercial Jobsite” mailed to
small employers in WA risk class-floor covering installers.
 215 copies of “Skid Steer Loader Operator Impaled by Rebar” mailed to employers in WA
risk class-building demolition contractors.
 394 copies of “Roofer Dies after Falling from Ladder or Roof” mailed to employers in WA
risk class-residential roofing contractors.
 420 copies of narrative “Operator Dies after Being Caught between Bulldozer’s Track and
Fender” mailed to employers in WA risk class-excavating and land clearing.
 336 copies of “Laborer Falls through Roof Opening” mailed to employers in WA risk classroof construction and repair.
WA FACE Investigation Reports:
 824 copies of “Machinist Dies after Being Struck by Rotating Steel Bar Stock in Lathe in
Washington State” mailed to employers in WA risk classes-machine shops, machine
manufacturing, machine operation and regional technical colleges.
 420 copies of investigation report “Operator Dies after Being Caught between Bulldozer’s
Track and Fender” mailed to employers in WA risk class-excavating and land clearing.
 450 copies of investigation report “Orchard Laborer Dies when Crushed Between a Motor
Grader and Semi-Truck in Washington State” mailed to employers in WA risk classorchards.
 193 copies of “Truck Driver Dies after being Run Over by Propane Transport Rolling
Backward at Bulk Plant” mailed to WA risk class-gas and oil dealers, natural gas
companies.
WA FACE Hazard Alerts:
 318 copies of “Successful Bathtub Stripping with Benzyl Alcohol as an Alternative to
Methylene Chloride” mailed to employers engaged in bathroom, tub, tile, porcelain,
remodeling and refinishing.
 563 copies in English and Spanish versions of “Hazards to Orchard Tractor and Machinery
Operators” mailed to employers in WA risk classes-orchards, fresh fruit and vegetable
packing.
D. Outputs: Prevention resources presented and distributed at conferences and
meetings: WA FACE prevention resources were distributed at several conferences and
meetings where the potential for impact was high due to the large audiences of health and
safety professionals, labor representatives, and young workers.
 Puget Sound Safety Summit: 10 meetings attended with approximately 3,100 FACE
documents distributed.
 Seattle Vicinity Construction Safety Council: 1 meeting attended with approximately 90
FACE documents distributed.
 Build-it-Smart: 1 meeting attended with approximately 90 FACE documents distributed.
 Mount Rainier Safety Meeting: 1 meeting attended with approximately 100 FACE
documents distributed.
 Washington State Contract Loggers Association Safety Day: FACE documents distributed
to 417 attendees.
 Young injured worker speaker series: FACE documents distributed to over 1500 students
at 5 regional high schools and 4 apprentice training programs.
 Washington State Apprenticeship Program Managers Meeting: over 200 FACE documents
distributed to apprentice program managers.
 Try-A-Trade-Day: FACE documents distributed to 654 student and apprentice attendees.
2. Improving Safety through targeted use of WA FACE Materials
A. Intermediate Outcome: Planned safety improvements by employers resulting from
WA FACE Investigation Report recommendations: WA FACE sent investigation
evaluations in the form of self-addressed stamped returnable postcards to employers who do
not receive FACE reports electronically to assess the quality, intended uses, and impact of
prevention recommendations on workplace safety.
Machinist (lathe) Operator Investigation Report-116 Responses:
 84% rated usefulness as good, very good, or excellent.
 91% rated readability as good, very good, or excellent.
 53% will distribute to employees/others.
 58% will use to identify hazards.
 55% will use for trainings/toolbox talks.
Bulldozer Operator (construction) Investigation Report-68 Responses:
 93% rated usefulness as good, very good, or excellent.
 97% rated readability as good, very good, or excellent.
 47% will distribute to employees/others.
 54% will use to identify hazards.
 88% will use for trainings/toolbox talks.
Motor Grader Operator (agriculture) Investigation Report-67 Responses:
 66% rated usefulness as good, very good, or excellent.
 84% rated readability as good, very good, or excellent.
 20% will distribute to employees/others.
 54% will use to identify hazards.
 63% will use for trainings/toolbox talks.
Propane Transport Driver Investigation Report-29 Responses:
 86% rated usefulness as good, very good, or excellent.
 93% rated readability as good, very good, or excellent.
 59% will distribute to employees/others.
 69% will use to identify hazards.
 62% will use for trainings/toolbox talks.
B. Intermediate Outcome: Documented safety training, hazard assessment and
abatement, and worker protection resulting from WA FACE recommendations (end
outcomes): WA FACE prevention resources are disseminated by email predominantly to
health and safety professionals. The WA FACE web-based electronic survey provides valuable
feedback from these users and documents the quality, uses, and impact of WA FACE
prevention resources on workplace safety. Of 57 total respondents, 92% considered WA FACE
products “Good to Excellent” resources in terms of usefulness and readability.
Overall opinion of WA FACE document?
Opinion
Poor Fair
Usefulness of materials
0%
9%
Readability of materials
2%
4%
How have you used this document?
Use
Percent
Personal awareness
67%
Trainings or tool box talks
59%
Distribute to
employees/others
48%
Post on bulletin board
36%
Use of safety gear
18%
Reporting hazards
11%
Good
18%
10%
Very good
43%
51%
Excellent
30%
33%
Changes after reading this document?
Changes
Percent
Identifying hazards
69%
Planning a job
29%
Use of safety gear
Setting up a job or work site
Procedures for completing a job
Choice or use of tools/equipment
25%
22%
29%
31%
Using Workers’ Compensation Data to Identify High Risk Workplaces for Work-related
Musculoskeletal Disorders (WMSDs)
Program Director: Barbara Silverstein, PhD, silb235@Lni.wa.gov, (360) 902-5668
Project Coordinator: Daniel Hunter, MA, hund235@lni.wa.gov, (360) 902-6836
The overall goal of this project is to develop and test a surveillance system to identify
prevention efforts for high hazard workplaces by industry sector and size for work-related
musculoskeletal disorders (WMSDs) like carpal tunnel syndrome or tendonitis in four body
regions shoulder, hand/wrist, back, or knee. We are comparing different exposure assessment
methods (Quick Exposure Checklist, Washington State Caution and Hazard Checklists,
ACGIH TLVs for Hand Arm Activity Level (HAL) and Low back). To this end, our team has in
the past year:
 Reassessed the magnitude and distribution of WMSD workers compensation (WC)
claims frequency, incidence, and cost by industry and NAICS size using the most
current available data;
 Conducted seventy-four (74) injured worker telephone interviews within ninety days of
identifying compensable WMSD claims with four or more lost workdays;
 Conducted fifty-two (52) management and union/safety committee interviews among
high and low incidence rate companies by industry group within each of seven NORA
sectors regarding injury experience, WMSD risk factors, training, employment patterns,
safety culture, and turnover to identify potential explanations for differences in WC
claims rates; and,
 Conducted fifteen (15) paired employer site visits to high and low WMSD incident rate
companies to identify potential differences in exposures, management culture, and
safety issue awareness via site walkthroughs, worker observations, and job-based
WMSD risk factor assessment.
Major Outputs
Company Site Visits for WMSD Risk Factor Assessment
 We identified Washington businesses from seven NORA sectors with both upper and/or
lower quartile incidence rates for WMSDs in one or more body regions (back, shoulder,
hand/wrist, and knee).
 In the past year, we have completed 20 site visits to 15 different participating companies
to conduct worker observations and job hazard assessments.
 We have visited fifteen (15) companies including manufacturers in the metal and wood
products industries, construction contractors (including roofing, plumbing, and HVAC),
nurseries and landscaping services, fruit growers and packers, and community and
nursing care facilities for the elderly.
 During these visits SHARP staff members have had the opportunity to consult with
company representatives regarding safety issues of specific interest to employers, and
have discussed suggestions for reducing exposures to WMSD risks.
 Additionally, our field teams have helped participating companies recognize and
highlight individual workers’ innovative solutions to potential hazards, encouraging
safety representatives to disseminate these ideas as best practices throughout their
broader worker population.
Job Evaluation Reports
 In the past year, we have generated and delivered fifteen (15) job evaluation reports
containing detailed analysis regarding potentially hazardous risk factors and targeted
recommendations for injury prevention as well as overall exposure assessments
including instances where jobs may currently meet or exceed industry best practices.
 Reports are generated directly from data gathered using the handheld digital checklist
and serve to supplement companies’ existing safety programs with objective findings
from professional occupational health experts; a color coded quick reference page helps
employers quickly identify jobs with potentially hazardous risk factors, and this year we
have generated and delivered thirty reports to participating companies.
Presentations and papers
 To date, Dr. Silverstein has presented the methods and early partial results to:
o University of Washington Department of Environmental and Occupational Health
Sciences faculty and students (April 2012 and May 2013)
o She also presented 3 papers at the 2013 triennial PREMUS conference in Busan
Korea, July 2013
 Hunter D, Silverstein B. Perceptions of Risk from Workers in High Risk Industries with
Work Related Musculoskeletal Disorders. Work: A Journal of Prevention, Assessment
and Rehabilitation. Accepted: July 14, 2013.
Exposure Assessment Tool: Digital Risk Factor Assessment Checklist App
 Risk factor data from company site visits are collected using a novel electronic checklist
application developed for this purpose by SHARP staff and deployed using a small
hand-held touch screen tablet. The checklist app affords the unique ability to observe,
enter, calculate and analyze data seamlessly in the field, and allows ergonomists to
identify and report potentially hazardous risk factors in real time.
 With the rise in handheld digital computing, we anticipate that this electronic WMSD
hazard checklist will find traction throughout industry with a broad user base among
regional and national occupational health professionals interested in identifying and
mitigating high-risk job tasks.
 Pending final analysis of the job data as compared to WC compensation claims data,
we will assess the predictive power of each tool for each of seven industry sectors and
tailor industry-specific job evaluation tools into the software the will incorporate major
evaluative components of several validated methods including the Washington State
Department of Labor and Industries’ Caution Zone Checklist, the Washington State
Hazard Zone Checklist, the Strain Index method, as well as the Quick Exposure Check
(QEC) method.
 The abundance of exposure parameters as well as the results derived using different
job evaluation tools has provided a foundation for us upon which to compare exposures
between companies with good injury records and those with poor injury records. During
worksite visits, we collected detailed information about jobs and their task activities
making it possible for us to (1) link specific task activities to potentially unsafe work
conditions, (2) provide specific explanations for their causes, and (3) develop
industry/job specific control measures.
Injured Worker Stories from Interviews
 During our conversations with injured workers, we have gathered substantial evidence
of the personal toll of WMSDs on the lives of both the injured worker and their families.
 We have also assessed the nature of risk at many of the jobs in high hazard industries
as well as workers’ detailed descriptions of how their injuries occurred and how they
might have best been prevented.
 Navigating a workers’ compensation system can be overwhelming, and we believe this
body of personal testimony will serve as an impetus for action—for employers, health
professionals, and insurance providers—to ensure injured workers’ successful return to
the workforce. Selected passages from a few recent interviews include the following:
o Personally, it affected everything in my life. It almost cost me my marriage.
Financially, we've lost almost everything we had. We're contemplating filing
bankruptcy. We've lost our TVs. We lost our washer and dryer. We've almost lost
our cars. Our kids--we've had to move out to a little ****hole house in a different
town because we couldn't afford the rent. I mean, it's affected everything in our
life. Can't afford insurance for my cars, I can't afford nothing. I had to go get on
welfare to get food for my kids. It's affected every part of my life.
o I've seen how easily you can lose a lot of stuff by an injury. I've lost so much, a
decent wage. I lost, probably an industry. I really can't go back to driving. I can't
see myself driving anymore. Not because of...well, it is because of the injury, but
not because it hurts or something along those lines. But I just, I have this fear,
almost a nightmare, of being on the side of the road in the middle of nowhere, I
mean literally nowhere, and hurting my back and not being able to get into the
truck.
NORA Surveillance Projects (TIRES): Trucking Injury Reduction Emphasis through
Surveillance (TIRES) Program
Program Director: Caroline Smith, MPH, smcb235@Lni.wa.gov, (360) 902-4528
Co-program Director: Dr. Barbara Silverstein, silb235@Lni.wa.gov, (360) 902-5668
The Washington State trucking industry has some of the highest costs and rates for workrelated injuries, however very little is being done to address injuries other than those caused
by motor vehicle collisions. Previous research by Washington State Department of Labor and
Industries, SHARP Program revealed that the most common and costly injuries in trucking are
musculoskeletal disorders, falls, motor vehicle collisions and injuries from being struck by or
against an object. SHARP determined from the case follow-up surveillance data of the first
TIRES grant that these injuries occurred during four particular work activities: loading and
unloading activities including manual handling, securing the load, entering and exiting the cab,
and walking around the job site. Determining and targeting the root cause of injuries is the
continuing mission of TIRES and has been the driving force of reaching industry employers
and workers through KeepTruckingSafe.org.
Outputs
Outputs are developed through a collaborative process using information obtained from
surveys completed by workers and employers, data extracted from injured worker claims and
interviews and the direct guidance of the TIRES steering committee which consists of industry
stakeholders such as employers, industry associations, labor groups and trainers, and
insurers. All materials are developed to support industry best practices and to enhance the
safety training of large and small employers.
For the period from July 1, 2012 to June 30, 2013, these outputs included:
 Online simulation training tools - Interactive, educational resource to be used by drivers
and training personnel 1. Lever vs. ratchet: compares the forces involved in using a ratchet
versus a lever load binder. 2. Tire chaining: gives workers the opportunity test their tire
chaining safety skills. 3. Load shift fatality: tells the true story of a driver who was killed.
Produced 3.
 TIRES E-news electronic newsletter - Introduces and educates managers and safety
personnel on the magnitude of specific injury types. 11 produced.
 True story narratives – Actual stories of Washington workers injured on the job. Includes
injury prevention tips. 6 produced.
 Tip sheets – Injury prevention tips for specific scenarios. 6 produced, includes 1
translation into Spanish as requested by our stakeholders.
 Posters – Eye catching and educational posters for employee awareness. 12 produced.
 Company corner – Guest author from a local company shares his views on safety. 1
produced.
 Peer review – Smith, C., Williams, J. Work related injuries in Washington State’s Trucking
Industry, by industry sector and occupation. Submitted to Accident Analysis & Prevention.
 Trade journal article – Williams, J. TIRES: Helping to reduce work-related injuries in the
commercial trucking industries. Published in Northwest Transporter, Winter, 2013.
 Website - We continue to build on an interactive website where industry stakeholders can
download free educational materials or share their own success stories.
www.KeepTruckingSafe.org.
 Social media - We have expanded marketing and outreach into social media tools such as
Twitter, YouTube and the TIRES Blog.
 Outreach – KeepTruckingSafe.org participates in industry events such as the World’s
Largest Truck Convoy to benefit the Special Olympics, the Washington Truck Driving
Associations’ Truck Driving Championships the American Historical Truck Society’s
national convention and the port of Seattle’s voluntary truck inspections.
 Presentations – Presented TIRES simulations at the Annual Council for State and
Territorial Epidemiologists (CSTE) in Pasadena, CA. June 2013.
 Company trainings – TIRES staff presented KeepTruckingSafe.org to a local company’s
annual meeting of safety staff.
Outcomes (Potential)
All TIRES publication are distributed through voluntary avenues, meaning people need to sign
up to receive our materials or download them from our web pages, therefore, visits to our web
sites are an accurate representation of the usefulness of the materials. During the past year,
there were over 86,800 visits to our web pages at
http://www.lni.wa.gov/Safety/Research/Trucking/Pubs/Default.asp and
www.KeepTruckingSafe.org.
The online simulation tools were developed in response to stakeholder requests for interactive
trainings to meet the challenge of training younger drivers who believe they are invincible (e.g.
Don’t Jump) and experienced drivers (e.g. Ratchet vs. Lever Binders) who don’t want to
change from the way things have always been done. We know the simulations have been
downloaded nearly 30,000 times. We don’t know how many companies have downloaded to
their company web sites or trainings, since the option is there and free to the public. We’ve
been told by company safety personnel that they are using them in their new hire trainings.
Our simulations are also available on external websites (e.g., SafetyDrivenCA) where they can
be downloaded. We do not have a count of those downloads.
Leveraging social media - Our Twitter account was launched on October 20, 2011. We
currently have 563 followers. On a typical week, our exposure is 8,000 accounts due to other
users retweeting (forwarding) our information. A YouTube training video was viewed over
1,000 times. At least one blog article is posted per week and a special is released to honor
each truck driver killed in Washington. The TIRES blog was visited 1,612 times over the past
year.
Outcomes (Intermediate)
TIRES educational materials are being used by occupational safety and health professionals
within the industry.
 TIRES training materials are used as a major component of Washington Teamsters
Training, train-the-trainer program for the trucking and construction industries.
 TIRES has been contacted by other states’ (AL, MT,MN and even Canada) workers’
compensation programs to partner with TIRES to develop additional training materials and
to use the materials already developed. Trucking injuries are similar across the globe so by
sharing data and strategies, we’ve collaborated to make our materials even better.
 TIRES is responding to stakeholder feedback by continuing to produce safety materials and
online training simulations. One of the largest truck driver staffing agencies in the nation,
contacted us regarding our jump force simulation. They want a copy of it to run in the lobby
of each of the 42 offices where potential truck drivers go for interviews.
NORA Surveillance Projects (TEMPS): Temporary Worker Surveillance Program
Program Director: Michael Foley, folm235@lni.wa.gov, (360) 902-5429
Outputs:
 Presentation at CSTE 2013 Conference (June 11, 2013): “The role of workers’
compensation data in occupational health and safety surveillance of temporary workers.
 Peer-review publication: “Contingent Workers: Workers’ Compensation Data Analysis
Limitations and Strategies”, submitted to American Journal of Industrial Medicine,
December 2012 (in review).
 Access databases created: claimant case-control matching; call tracking/interview
completion; claimant interview responses.
Aim #1: Characterize the magnitude of workers’ compensation claims incidence among
workers employed by temporary agencies grouped by industry sector, as represented by risk
class, and compare to that of workers employed under standard employment arrangements
working in comparable industries and occupations.
Potential Outcomes:
 Time-loss claims rates in 2012 continue to show that for twelve temporary risk classes
and their selected comparable permanent risk classes there was a significant excess
rate of injury for temporary workers. The greatest discrepancy in injury rates between
temporary workers and their permanent counterparts are in the following industry
sectors: machine operation, vehicle operation, construction, agricultural services, food
services and assembly operations.
 Other differences between temporary workers and their matched permanent
counterparts which may be related to increased probability of injury include:
o Median age at injury for temporary workers is 4 years younger than for
permanent workers.
o Gender distribution for temp workers is 75% male versus 62% male for
permanent workers.
o Median number of days on the jobsite for temp workers is about 13% that of
permanent workers.
 Severity of injury may be greater for temporary workers: the median number of time loss
days for temps is 68% greater than it is for matched permanent workers. This may also
reflect greater difficulty in managing the return to work process for injured workers
without a regular relationship to a particular workplace.
 The distribution of injuries by injury type (e.g. struck by; falls; caught in, etc.) is very
similar to that of matched permanent workers.
Aim #2: Conduct 80 follow-up interviews per year with temporary workers and a matched set
of standard workers to gain information about tasks, hazards, safety training, and ability to
identify and report hazards. To date we have completed the following:
Temporary
Workers
# claimants selected for interview
# calls made
# interviews complete
# completed interviews linked with a
matched interview
Permanent Workers
Total
553
950
168
488
850
152
1,041
1,800
320
71
123
194
Potential Outcomes:
Preliminary results from interviews with injured temporary workers and their matched
counterparts in standard, permanent employment showed that:
 Exposures to injury hazards were perceived by claimants to be distributed similarly
between temporary and permanent workers, with the total level of hazard exposure
slightly higher for permanent workers than for temporary workers. Greatest exposures
for both categories of worker were to manual handling, machinery and falls
 Temporary workers were much less likely to be asked about their prior skills or
experience before starting a job assignment than were permanent workers.
 Temporary workers received training that was less frequent and perceived to be less
adequate than that of their permanently-employed peers. A higher percentage of
temporary workers report receiving no safety training from their jobsite employer.
 Temporary workers report receiving greater supervision at the job site than do their
permanent counterparts.
Maintaining and Improving Pesticide-Illness Surveillance in Washington State
Performance Location: Washington State Department of Health (DOH)
Program Director: Joanne B. Prado, MPH, joanne.prado@doh.wa.gov, (360) 236-3172
Major Outputs:
 Completed 200 pesticide-illness investigations and annual upload of case data to
NIOSH Sentinel Event Notification System for Occupation Risk (SENSOR).
 Planned illness prevention actions with partners and provided health information to farm
workers, pest control operators, county and city employees, and representatives of
government-owned housing.
 Developed reports and articles, two of which were published in a peer-reviewed journal.
Potential Outcomes:
DOH reported 331 confirmed cases of pesticide-related illness due to agricultural pesticide drift
from January 2002 through December 2011, with 65% of these cases being agricultural
workers. One of the priorities for prevention identified by DOH is to improve communication
between farms, and between sprayers and work crews on the same farm. The priorities also
focus on tree fruit as the primary industry of concern, and identify the air blast sprayer method
of application as being most commonly associated with drift cases in workers and other
bystanders.
Content about preventing pesticide illness in schools, and Integrated Pest Management (IPM)
approaches to managing pests was added to the DOH Healthy Schools Website.
http://www.doh.wa.gov/CommunityandEnvironment/Schools/EnvironmentalHealth/Pesticides.a
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Intermediate Outcomes:
Information obtained through DOH pesticide illness surveillance was provided to Washington
State Division of Occupational Safety & Health (DOSH) and applied to their investigations of
safety practices at more than 8 worksites. Examples are:
 A licensed pest control operator working for an irrigation district was exposed to acrolein
when he checked the application equipment. He sustained severe injury and was
hospitalized.
 Two farm workers developed severe symptoms after they were directed to enter cherry
orchards 2 days after a Guthion application. Guthion is a restricted use pesticide and
the re-entry interval after application is 15 days. DOSH cited employers for breaking reentry rules and for not requiring respirators.
 Application of lambda-cyhalothrin, a synthetic pyrethroid, to an apple orchard drifted
onto 9 workers. They were decontaminated by emergency response van and treated at
a hospital.
Surveillance findings about the root-causes of pesticide-related illness in farm, forestry, and
landscape occupations were incorporated into safe practices trainings conducted by
Washington State Departments of Agriculture, Labor and Industries, and Natural Resources.
Pesticide-Illness surveillance data involving the control of bed bugs and hazards of “bugbombs” is helping to promote Integrated Pest Management (IPM) approaches among
managers, maintenance personnel, and residents of government-owned housing. DOH
Pesticide Program staff met with King County government and public housing authorities to
discuss pesticide-illnesses caused by misuse of pesticides in multi-unit dwellings in King
County. With guidance and education materials from DOH Pesticide Program staff, King
County Community Health Workers provided safe and effective pest control trainings at 7
locations in King County. These trainings were attended by multi-ethnic, multi-language,
workers and residents of King County-owned housing. DOH staff introduced King County
contacts to specialists in IPM techniques from Washington State University and are working
together to plan a statewide “train-the-trainer” workshop on IPM approaches to pest
management in multi-unit housing.
DOH Pesticide Program staff provided data and participated in work sessions of the
Washington State House Committee on Labor and Workforce Development. Staff presented
the causes of agricultural pesticide drift, provided case examples, and continues to work with
partners to develop legislative and other strategies to prevent illness from pesticide drift.
Manufacturers of pesticidal strips that contain the chemical “dichlorvos” voluntarily agreed to
product packaging and label changes, recommended by DOH after staff shared data about
unintended human exposures and illness from the use of this product with the Washington
State Department of Agriculture and the Environmental Protection Agency. Product packages
will now be more clearly labeled to avoid use indoors (offices, kitchens, bedrooms, or
elsewhere) where people may be present for extended periods of time.
End Outcomes:
The extent to which surveillance activities have resulted in reduced pesticide-illness and
improved safety at worksites is not known. One potential end-outcome is a reduction in illness
cases involving early re-entry to fields where pesticides have been applied. DOH Pesticide
Program staff is exploring whether a downward trend may follow improved and expanded
education based on illness surveillance findings about the hazards of early re-entry. The
impact of penalties for infractions is also being examined.
Publications and Presentations:
Hudson NL, Kasner EJ, Beckman J, et al. “Characteristics and Magnitude of Acute PesticideRelated Illnesses and Injuries Associated With Pyrethrin and Pyrethroid Exposures-11 States,
2000-2008.” American Journal of Industrial Medicine. May 2013.
Kasner EJ, Deralis JM, Mehler L, et al. “Gender Differences in Acute Pesticide-Related
Illnesses and Injuries Among Farm workers in the United States, 1998-2007.” American
Journal of Industrial Medicine. July 2012.
(Reported by) Rodriguez L, Prado J, Holland A, Beckman J, Calvert GM. “Notes from the Field:
Acute Pesticide-Related Illness Resulting from Occupational Exposure to Acrolein-Washington
and California, 1993-2009.” Centers for Disease Control and Prevention, Morbidity and
Mortality Weekly Report. April 26, 2013.
Washington Department of Health, Pesticide Program. “Case Classification for Acute
Pesticide-Related Illness or Injury.” June 2013.
Pesticide Program staff presented case studies and discussed root-causes and prevention
strategies with participants at 6 trainings required by Washington Department of Agriculture for
pesticide applicator licensing.